Summary

Alcohol-use disorder is a common psychiatric disorder that is multifactorial in aetiology, chronic in nature, and is associated with a wide variety of medical and psychiatric sequelae.

Tolerance, withdrawal, impaired control of drinking behaviour, and continued alcohol use despite adverse consequences are some important features of alcohol dependence.

Alcohol withdrawal syndrome can follow cessation or reduction in alcohol consumption. Withdrawal can be a serious medical condition. It is best monitored by use of a structured instrument: the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). Benzodiazepines are the definitive medical treatment.

Binge-drinking, alcohol abuse, and mild alcohol dependence may be addressed by brief physician-based interventions, or psychological interventions such as cognitive behavioural therapy.

Moderate or severe alcohol-use disorder requires multi-modal treatment. Detoxification in an inpatient or outpatient setting may be necessary. The goal of detoxification is to minimise withdrawal symptoms and to facilitate entry into an ongoing, multi-modal treatment programme directed towards assisting the patient in maintaining abstinence.

Medications, including naltrexone, nalmefene, acamprosate, and disulfiram, can be successfully utilised for selected patients to improve their chances of maintaining abstinence. Nalmefene is no longer available in the US.

Definition

Alcohol-use disorder is a term used to refer to the misuse of alcohol. Several specifically defined conditions better categorise patterns of alcohol misuse.

Problematic alcohol use is classified in the American Psychiatric Association's Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5) as alcohol-use disorder, with severity specified as mild, moderate, or severe, depending on the number of diagnostic criteria that have been met.
[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.

Alcohol-use disorder results from a variety of genetic, psychosocial, and environmental factors.
[2]Swift RM. Drug therapy for alcohol dependence. N Engl J Med. 1999 May 13;340(19):1482-90.
http://www.ncbi.nlm.nih.gov/pubmed/10320388?tool=bestpractice.com
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
It is characterised by increased tolerance to the effects of alcohol, the presence of characteristic withdrawal signs and symptoms, and impaired control over the quantity and frequency of drinking.
[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.
Alcohol-use disorder can be associated with a variety of medical and psychiatric sequelae. The World Health Organization's tenth edition of the International statistical classification of diseases and related health problems (ICD-10) defines alcohol-use disorders in a similar manner.
[3]World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Geneva, Switzerland: WHO; 2016.
http://apps.who.int/classifications/icd10/browse/2016/en#/

Disclosures

Dr Colin Drummond would like to gratefully acknowledge Dr Julie R. Pittman, Dr Philip H. Chung, Dr Robert M. Swift, and Dr Lorenzo Leggio, previous contributors to this topic. JRP, PHC, and RMS declare that they have no competing interests. LL is an author of a reference cited in this topic.